The U.S. Commitment to Global Health Recommendations for the Public and Private Sectors (2009) / Chapter Skim
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6 Set the Example of Engaging in Respectful Partnerships
6 Set the Example of Engaging in Respectful Partnerships
Pages 153-168
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From page 153... ...
The Gates Foundation, which has firmly established its place on the global health governance map by mobilizing resources for innovative financing mechanisms and product develop 1 Inpreparing this section of the report, the committee drew heavily on the background paper prepared by Mr. Lawrence Gostin and Ms.
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From page 154... ...
and the UN are comprised of member countries; while nonstate participants are recognized and engaged to some degree by both, they cannot vote in formal decision-making processes. At the country level, traditional mechanisms of bringing together external donors have neglected to engage NGOs and private sector providers, even though they play a crucial role in financing and delivering care.
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From page 155... ...
WHO's work in this area has influenced governments as well as independent philanthropic organizations within the United States, guiding their investments in sound and cost-effective health strategies. When New York City Mayor Michael Bloomberg recently joined forces with the Gates Foundation to commit $500 mil lion to WHO's program to reduce smoking in 15 countries where more than twothirds of the world's smokers live, his philanthropic program selected countries per the FCTC's protocol and adopted its first six initiatives (Myers, 2008)
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From page 156... ...
So while many multilateral organizations are also crucial players in the health arena, the United States, along with the international community, should support WHO's leadership position in global health. To this end, the United States should pay its fair share of the organization's core budget and provide technical expertise, while also requesting a rigorous external review of the agency.
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From page 157... ...
The U.S. government should support a rigorous, multinational, external review of WHO, with a view to producing future-oriented recommendations as part of broader UN reforms to ensure that the organization is appropriately struc tured and funded to meet the global health challenges of the twenty-first century.
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From page 158... ...
The ongoing practice by member states of primarily funding outside the WHO core budget -- which receives only 28 percent of non-earmarked funds, while 72 percent goes into specific programs2 that donors can control and claim credit for -- has transformed WHO into a very "donor-driven" organization with increasingly fragmented and compartmentalized programs (Gostin and Mok, 2008; WHO, 2007b)
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From page 159... ...
As of November 2008, the United States owed more than $140 million in back dues for 2007 and 2008 (Smith, 2008) -- a significant share of the $900 mil lion that constitutes WHO's core budget.
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The multitude of new participants in health should not obscure the reality that national governments should ultimately hold responsibility for providing health services to their own populations. Low- and middle-income countries typically receive health assistance from numerous channels: bilateral and multilateral donors; intergovernmental organizations, such as the World Bank, UNICEF, and UNDP; and international NGOs, such as CARE and Save the Children.
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From page 161... ...
Support for Country-Led Health Plans To reduce the burden on recipient countries in coordinating donor efforts around a basic health plan, donors should support countries in developing results
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From page 162... ...
Country-led health plans, at a minimum, require countries to articulate a health strategy that is "consistent with the macroeconomic and fiscal policies of the country, articulates specific goals in a results-based framework, and aligns the development of health systems and cross-sectoral contributions to the health sector with the achievement of sustainable improvements in health outcomes through a balanced and multi-sector development strategy" (World Bank, 2006)
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From page 163... ...
Regardless of which of these country-coordinating mechanisms is used, donors should deliver aid in ways that support technically and financially sound country-led health plans to the greatest extent possible, in order to ensure that countries retain ownership and accountability for the health of their populations and to promote long-term sustainability. This does not necessarily mean that donors must pool their funding into "one country pot." Yet delivering a greater proportion of aid that is predictable, long term, on plan, and on budget -- and provided under the assumption that governments implement agreed-upon strate gies in a transparent fashion -- would be a tremendous step forward in supporting the long-term capacity of national health systems.
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From page 164... ...
Rather than directly providing services, international NGOs should make capacity building and health systems strengthening their primary goals; by acting as catalysts or facilitators, NGOs can improve the sus tainable delivery of services to marginalized populations. One of the most important roles an NGO can fill is as a collaborator between the various participants in public health, specifically communities, health institu tions, bilateral and multilateral donors, academia, and other NGOs working in complementary fields.
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From page 165... ...
Recommendations 6-2. To ensure that countries retain ownership and accountability for the health of their populations and to promote long-term sustainability, donors should support recipient countries in developing results focused, country-led agreements that rally all development partners around one country-led health plan, one monitoring and evaluation framework, and
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From page 166... ...
To reduce the burden on countries in coordinating donor efforts around a basic health plan, all funders of global health should strive to deliver a greater proportion of aid in support of technically and financially sound country-led health plans provided on the premise that the recipient government implements agreed-upon strategies in a transparent fashion. REFERENCES Abbasi, K
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From page 167... ...
2008. Michael Bloomberg and Gates foundation join in historic commitment to combat global tobacco epidemic.
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From page 168... ...
British Medical Journal 325(7375)
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